Fat embolus in femur fractures: a comparison of two reaming systems

Abstract

Objective To measure the amount of fat presented to the right heart during reaming and nail placement using two different reamer systems. Design Prospective, randomized clinical trial. Setting University-based Level I Trauma Center. Patients 20 patients with femur fractures. Intervention Patients with femur fractures were treated with intramedullary nailing using either reamer-irrigator-aspirator or a conventional reamer. Main Outcome Measure four-chamber trans-esophageal echocardiogram was used to quantify the amount of fat presented to the right atrium. Results There were 2 female and 18 male patients enrolled, 10 in each group. There was no significant difference (p=0.10) between reaming systems on the opening reamer, which was expected since both trial limbs used the same opening reamer. However, during the first pass of the reamer, the RIA showed a nearly-significant decrease in the volume of fat in the right atrium (p=0.06). During passage of the nail, there was a significant difference with Group B having less fat embolus than Group A (p=0.01). The power of this study is 0.81. The mean ISS was not significantly different between the two groups, nor was the sex, age or race. There was one death from cardiac complications in a patient who showed no fat during any phase of the procedure. This patient had significant mitral and aortic regurgitation pre-operatively. There was one patient with clinical fat embolism syndrome and one patient with a nonunion. Conclusions There is a statistically significant difference in the amount of fat presented to the lungs using a RIA versus conventional reamer.